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What the Heck is That? When to See a Dermatologist

Airdate: 8/24/2013

If you're wondering what that spot, bump, or mark on your skin is, this is the show for you! Learn how to tell if a skin concern deserves a doctor's attention and when you can treat the issue yourself. We discuss the best products and, should you decide to book an appointment, what you should expect from a visit to the dermatologist.

Paula Begoun:

Hello. I'm Paula Begoun with Bryan Barron, "Keeping you Beautifully Informed." We want you to stay beautifully informed. We're part of the Paula's Choice Research Team. Bryan and I have been writing books together on beauty and skincare for 13 years. I started writing in 1984 with my first book, "Blue Eye Shadow Should Be Illegal." And Bryan joined me for the, which edition of the book?

Bryan Barron:

Fifth edition of "Don't Go to the Cosmetics Counter Without Me."

00:00:29

I hit the ground running.

Paula Begoun:

You did. Because it was the first thing I made you to do was do a review for your interview!

Bryan Barron:

Yeah.

Paula Begoun:

The Aveda line.

Bryan Barron:

Right. Right.

Paula Begoun:

And I thought, and our famous story, our personal famous story is, and I said, "Just write the review. Don't look at what I wrote. And just come up with your own review." And I read your review and I thought you had copied me.

Bryan Barron:

Yes.

Paula Begoun:

I thought, darn, I told him not to copy me.

Bryan Barron:

All your hopes were dashed.

Paula Begoun:

And sure enough I went back and looked at what I had written and you had not copied a word.

00:01:05

You just sounded, your writing sounded just like my writing. And for the past 13 years we rarely can tell what the other has written or not written. Our styles have separated a little bit over time.

Bryan Barron:

Mm-hmm.

Paula Begoun:

But really for many, many years I would say, "Who wrote that? Did you write that?' And you'd go, "I think I wrote that. Did you write that?"

00:01:28

So, we are our own yin and yang. We are part of the Paula's Choice Research Team as I said. We're a much bigger team, but it's just Bryan and I here. Our work is found on PaulasChoice.com. That's our skincare line. We started that in 1995. A very small collection has now expanded into a beautiful collection of skincare products for all skin types. We also have our reviews from "Don't Go to the Cosmetics Counter Without Me" on the website at PaulasChoice.com, as well and a ton of articles.

00:02:05

And actually what we're going to talk about today is when to see and when not to see a dermatologist. In other words, when you see something on your skin and you go, "What the heck is that? Or what am I supposed to do about that?" And you wonder whether or not you should or shouldn't see a dermatologist, which can be pricey, or difficult, or time-consuming to get in. It's nice to know what a dermatologist can and can't do for you.

00:02:29

What you can do on your own. What's over-the-counter. And just to be very clear, let me say this from the very, very top, is if you are in doubt at all as to what is going on with your skin, you must -- you must -- see a dermatologist. You cannot second guess the health of your skin. But, if you're wondering, we can give you some suggestions as to how to interpret when to go to a dermatologist and when not to go to a dermatologist.

00:03:00

Because it turns out that for many problems -- you know, skin is huge, right? A great big organ covering the insides of your body and depending on what part of your body... -- I mean, your heels can have calluses. You can have dry, terrible cracked dry hands, wrinkles. You can have brown spots. You can have acne. You can have dandruff. Dandruff isn't a hair problem; it's a scalp problem.

Bryan Barron:

Scalp problem, right. Eczema, Psoriasis, Rosacea…

Paula Begoun:

Oily skin.

00:03:28

Sebaceous Hyperplasia, which is a distorted oil gland. You can have Keratosis Pilaris, which are red bumps on the back of the arms and thighs. I mean, on and on and on. Tons of problems. It turns out that most of them you can actually take care of beautifully on your own. And we'll talk about those. But, let's start with when to see a dermatologist. When absolutely without question you're better off not even thinking of doing anything about it yourself, but to absolutely make that appointment with a dermatologist.

00:04:08

And the first one that is something that I wish over-the-counter products could treat, but it can't, and that's cystic acne.

Bryan Barron:

Yeah.

Paula Begoun:

But it can't. And that's cystic acne. Cystic acne is a nasty, nasty type of acne where the skin really swells with pimples to the point of distorting the actual, not just a swelling, but an actual distortion creates dents in the skin.

That is how you get those ice pick or depression type scars after a bad cystic blemish is because the support structure, it's gone.

00:05:01

It's like a landslide.

Paula Begoun:

Exactly. It's literally been destroyed. It's not that you can't try over-the-counter products, of which the classic would be making sure you're not using anything irritating. You can't scrub away any acne.

Bryan Barron:

Please don't try to scrub cystic acne. You will always make it worse, and angry, and increase your risk scarring.

Paula Begoun:

You will always make it worse.

00:05:30

So, you can absolutely try a benzoyl peroxide product. You can absolutely try a salicylic acid product with a gentle cleanser. But generally speaking, after just a very, you know, two or three months, if you haven't seen any improvement, you're not going to.

Bryan Barron:

Right.

Paula Begoun:

And you really do need to go to see a dermatologist, either for oral antibiotics. I'm not fond of oral antibiotics for many reasons, but when you have seriously problem cystic acne it is sometimes something to consider.

00:06:01

There are topical antibiotics that are not over-the-counter that a dermatologist can prescribe. And, of course, in very extreme situations oral, well, Accutane is actually out of the picture now. But the active…

Bryan Barron:

But not Isotretinoin.

Paula Begoun:

Right. So, the generic version, many doctors are still prescribing a very serious oral anti-acne product that can actually heal acne.

00:06:28

You might have to take other courses of it, but for a long time, and for some people permanently, can actually heal acne. So, cystic acne is probably one of the ones that I could -- because if you have mild to moderate acne, most of the time over-the-counter products take brilliant care of it.

Bryan Barron:

You don't need to see a dermatologist for that type of acne. And given how long the wait can be to see some dermatologists, it's almost -- it's sort of like going to see the doctor when you have a bad cold thinking that if the doctor gives you an antibiotic then you'll get better. Antibiotics don't work on colds.

00:07:03

And it's not that a dermatologist can't help mild to moderate acne, but there's so much you can do for a lot less money…

Paula Begoun:

A lot less money.

Bryan Barron:

…on your own that it just makes sense to try that approach first, but as Paula was saying, if it is the cystic variety, if you want to try the over-the-counter skincare for a couple of months, if you're not seeing improvement though, or if you're noticing it's getting progressively worse no matter what you do, definitely see your dermatologist.

Paula Begoun:

Definitely see a doctor.

Bryan Barron:

At the very least see your general care practitioner. Let them know what you're dealing with. And you can check out our all about acne and cystic acne articles at CosmeticsCop.com to learn more.

Paula Begoun:

So, the other one that I think is sometimes easy to ignore and something that it would be dangerous to ignore would be dark discolorations that kind of pop up on your skin and start darkening, look irregular.

00:07:59

Maybe they are cracked and bleed and don't seem to heal.

Bryan Barron:

That's the big one right there. Any dark spot, especially if it's dark brown to black, that seems to come on suddenly and it bleeds occasionally when there's some friction against it, and no matter what it just doesn't go away.

Paula Begoun:

And just looks odd. Dark and odd and has an irregular shape. Do not assume that it's a brown spot. If it is a dark brown spot, you really do need to have a dermatologist take a look at it and make an assessment as to whether or not it's… - Some might be skin cancer.

00:08:42

It probably isn't, but you don't want to guess that one. And the only person who can tell you is a dermatologist.

Bryan Barron:

Right. Those marks, they tend to be more common in areas that do get a lot of sun. For example, the forearms, maybe the neck. In women, depending on the types of tops they wear, they could see them on the chest.

00:09:02

Men may see them on the back or the shoulders, especially if they have a job that keeps them outside quite a bit. But, it's worth noting that those marks can also show up in areas where the skin rarely sees the sun, such as your backside, your buttock area, between the toes.

Paula Begoun:

The groin.

Bryan Barron:

The groin area. So, it's just because you see a suspicious mark in an area that doesn't see sunlight, don't assume that it can't be skin cancer, because skin cancer can show up anywhere on the body.

Paula Begoun:

Actually a doctor just told me something about skin discolorations, the dark skin discolorations we're talking about, and there's actually a term in the dermatology world called Nylon Cancer. Nylon skin cancer.

00:09:49

Isn't that a…not that nylons have anything to do with causing it, but that a lot of melanomas show up on the legs.

Bryan Barron:

Okay.

Paula Begoun:

Because women tend to, if they're wearing skirts, and they're walking around, they might have sunscreen on their face, they may even have it on their hands, but they're not going to have it on their legs. That women during the day, if they go out in the sun, or they're wearing shorts, they forget to put sunscreen, or just don't even think about putting sunscreen on their legs.

Bryan Barron:

Yeah.

00:10:21

They don't want white legs.

Paula Begoun:

Or they just forget to do it. So, they actually have a term for nylon, what they call nylon skin cancer. Again, not because nylons have anything to do with it, but that it shows up on the legs. And you wouldn't think that that would be a place where skin cancer would show up.

00:10:41

And actually we're talking particularly melanoma.

Bryan Barron:

Before we move onto the next one, just as a reminder about what to look for for skin cancer, the American Academy of Dermatology recommends keeping your ABCDs in mind when you're looking, giving yourself a self-check, looking at moles, dark spots, freckles.

00:11:02

You want to pay attention to asymmetry. Normal moles or freckles are completely symmetrical. If you were to draw a line through a normal spot you'd see you'd have two symmetrical halves. In cases of skin cancer, spots typically aren't the same on both sides. That's particularly notable if you have a spot that was once perfectly round and you're seeing that the asymmetry is now different. You want to pay attention to the border. A mole or spot with blurry or jagged edges could be cause for concern. They typically have smooth edges.

00:11:32

Color. A mole that has gone from medium or café au lait type brown to dark brown or black is definitely cause for concern. Or if it turns reddish black, or you see bleeding, big warning sign there. The diameter is also -- that's the D in the ABCD. If it's larger than a pencil eraser, which is about a quarter inch, it needs to be examined by a doctor.

Paula Begoun:

That small?

Bryan Barron:

Yeah.

Paula Begoun:

So, ABC.

Bryan Barron:

Asymmetry. Border.

Paula Begoun:

Border for B. C, Color. And D, Diameter and how big it is. That's great.

00:12:06

ABCD. The next one is itching and rashes that won't go away. Now, most itching and rashes you can try, well first of all, keep skin moist. Use a really good, particularly on the hands and elbows, or any place you have very dry skin is choose a very emollient rich moisturizer. For some types of itching and rashes you can use an over-the-counter cortisone cream.

Bryan Barron:

The Cortizone-10s, they still make that Hydratensive lotion that we like.

Paula Begoun:

Oh, the one because it's gentle and has a beautiful base?

Bryan Barron:

Yes.

Paula Begoun:

What is that called? Cor Ten? What is that?

Bryan Barron:

It's Cortizone-10 is the brand name.

Paula Begoun:

Cortizone-10.

Bryan Barron:

But it's a Hydratensive lotion and it's their aloe formula. Whereas most tubes of cortisone are about a half an ounce to an ounce, and they're kind of designed more for spot treatment.

Paula Begoun:

And they're not very elegant.

00:13:02

They don't feel great.

Bryan Barron:

No. Right.

Paula Begoun:

They're kind of a dry, tacky feeling.

Bryan Barron:

Yeah.

Paula Begoun:

This is a very beautiful, elegant…

Bryan Barron:

Body lotion that happens to be medicated with cortisone. So, it's a great option. And you can find it in any major drugstore. It's a great option for use over larger areas with itching and rashes.

Paula Begoun:

Right. And again, when this is something you would try, you don't want to use cortisone cream too often. You want to use it only to control the itch and then stop when the itch or the rash goes away. If it comes back, do it again.

00:13:32

But you want to use cortisone as infrequently -- any cortisone product as infrequently as you can to keep the problem under control. However, with the best moisturizing and over-the-counter cortisone creams, for some rashes and for some itching, a topic dermatitis in particular, or some forms of eczema, just moisturizing and an over-the-counter cortisone cream is not going to be enough.

00:13:58

Absolutely what a dermatologist can prescribe is critical. And they have quite the arsenal of medications that they can recommend to get your rashes or itching under control.

Bryan Barron:

Yeah.

Paula Begoun:

Because it can be things like, I mean, some problems can be ringworm, which actually can be treated over-the-counter. By the way, ringworm isn't a worm. It's a fungus.

Bryan Barron:

Yup.

Paula Begoun:

They call it a worm because of the way it looks under a microscope.

Bryan Barron:

And men may know it as jock itch.

Paula Begoun:

It's not athlete's foot. It's jock itch…

Bryan Barron:

Different fungus but same type of thing.

Paula Begoun:

Different fungus…same type of thing.

00:14:41

But the kind that's jock itch, and the kind that can show up on the body, it's just the way that fungus looks under a microscope. But it's not like a worm-worm. And some of that, that actually can be treated. You can try treating it over-the-counter with Lotrimin, Ketoconazole…

Bryan Barron:

Mm-hmm. Miconazole. Tinactin.

Paula Begoun:

Tinactin.

Bryan Barron:

Those are some of the brand names out there.

Paula Begoun:

All those things.

00:15:05

And so you can give that a try. But once it's stubborn and it ain't going away, you absolutely need to talk to a dermatologist who can diagnose it, make sure that your personal self-diagnosis is correct, and get the best medication for it.

Bryan Barron:

Have you ever had poison ivy or poison oak?

Paula Begoun:

No, but my ex-husband did.

Bryan Barron:

So, just as a quick aside, because both of those situations…

Paula Begoun:

It was terrible.

Bryan Barron:

…can cause intense itching and rashes. So, what's the protocol there?

00:15:33

Can you treat those yourself? Or should you see a doctor?

Paula Begoun:

Well, it depends how severe it is. In the case of my ex-husband, it was so bad, we tried over-the-counter cortisone. You know, you wash it really well. We put…

Bryan Barron:

Do you take an aspirin or an anti-inflammatory orally?

Paula Begoun:

We didn't. We probably could have tried a Benadryl for a histamine reaction.

00:16:00

I don't remember at the time why we didn't do that. But, we washed it really well. We put on some cortisone cream to reduce the inflammation and it just got progressively worse to the point where I thought his skin was going to fall off. We actually went to the emergency room. They did give him Benadryl. They also gave him some steroids, some really strong topical steroids.

00:16:28

But, yeah, depending on how -- some people get a very severe -- like for example, he was also allergic to bee stings. So, he had a strong histamine reaction, allergic reaction, to things anyways.

Bryan Barron:

Sure.

Paula Begoun:

So, yeah, the poison ivy/poison oak thing was just a terrible reaction. And had I thought clearer I would have used his EpiPen, which is a fast dose of an antihistamine. An intense dose of antihistamine, or given him a Benadryl. I don't know, just for whatever reason at the time I just thought it was going to go away.

00:17:06

It didn't. it just never occurred to me at the time, this is so many years ago, that poison ivy can look that tragic. I mean, literally, where I thought his skin was curling, bubbling up off of his skin.

Bryan Barron:

We've heard from some women over the years who have gotten poison ivy on a hike or on a camping trip, and they've gotten over the worst of it in terms of the itching and the uncomfortableness of it.

00:17:32

but their skin, apparently some people their skin can remain unsightly for weeks.

Paula Begoun:

For weeks.

Bryan Barron:

You get like these track like red streaky marks that just will not…

Paula Begoun:

Like hives that don't go away.

Bryan Barron:

Yeah. That just won't go away.

Paula Begoun:

It can be severe for some people. So, if you get it, and it starts, I mean, for some people it's just mild and an over-the-counter, you know, washing it well, washing -- not scrubbing it -- but really washing it well, particularly your hands.

Bryan Barron:

Your hands and nails.

Paula Begoun:

Because it's a resin. And that's what happened to him.

00:18:04

He started touching other parts of his body. I don't even want to say what parts. I mean, it was sad. It was sad! It was sad.

Bryan Barron:

Are the boys okay?! Ha!

Paula Begoun:

Ha! The doctor -- should we be saying this over the radio? The doctor at the emergency room wanted to reassure me he didn't have a venereal disease. And I said, "I'm not worried that he has a venereal disease. I'm just worried nothing falls off!"

00:18:31

Oh, I can't believe how terrible it looked. I'll never forget it. So, having said that, which is probably more information than anybody wants to hear, yes…

Bryan Barron:

Sometimes that's how we roll.

Paula Begoun:

You just have to get to the doctor. You don't want to, especially with things like poison ivy or bee stings or things where you might have an allergic reaction.

Bryan Barron:

Snake bites.

Paula Begoun:

But severe itching, severe rashes, you got to get to a doctor. And sometimes not just to a dermatologist but to an emergency room.

Bryan Barron:

Skin disorders and skin that won't heal.

Paula Begoun:

You know, that's an interesting one. I actually have experienced where I've gotten a sore and the sore just never seems to heal.

00:19:12

And you can try putting on antibacterial medication, and you should, absolutely. If it's looking red and inflamed…

Bryan Barron:

Like Polysporin?

Paula Begoun:

Like Polysporin. Like Bacitracin. Like Betadine.

Bryan Barron:

Uh-huh.

Paula Begoun:

Betadine, that's what it's called, right?

Bryan Barron:

Yeah, with the iodine.

Paula Begoun:

Right. And so you can try all of that.

00:19:32

But sometimes like we were talking about ringworm, it isn't bacterial. It's actually a fungus infection, or some other kind of critter got into the skin, a tick bite, some kind of insect, a flea, something else can be…

Bryan Barron:

Ugh.

Paula Begoun:

I know. Should we stop talking about this?

Bryan Barron:

No, it happens. I mean, it happens.

Paula Begoun:

It actually happens frequently, especially in the summer when you're hiking around.

Bryan Barron:

Yeah, chiggers.

Paula Begoun:

So, things can get into the skin that if the antibacterial medication or antifungal medication isn't taking care of it after about a week, you need to get to the doctor and find out why a sore isn't healing.

00:20:12

You don't want to play around with that much longer.

Bryan Barron:

You know, another type of sore that can occur outside, or even like working in the garage that may not heal, is a spider bit.

Paula Begoun:

Oh, nasty. That's a histamine. That's an allergic reaction, like a bee sting.

Bryan Barron:

But the brown recluse spider bite, that can actually cause the skin to ulcer if not…

Paula Begoun:

Oh, it can be deadly.

Bryan Barron:

It can be deadly.

Paula Begoun:

Do we have brown spiders in the United States?

Bryan Barron:

Brown recluse?

Paula Begoun:

Yeah, the brown recluse spider?

Bryan Barron:

Yes.

Paula Begoun:

We do?

00:20:41

In Seattle?

Bryan Barron:

I don't think they're in Washington state, at least none of been reported. We have black widow spiders here for sure.

Paula Begoun:

No kidding?

Bryan Barron:

The very first time I ever saw a black widow spider in person was when I first moved here in 1998 and we were renting a house. And I put some of our extra stuff in the garage. And it was an older garage that had like this kind of dilapidated wood shelving in the back.

00:21:07

But they cleared out some room for us. And it was dimly lit. And I went to turn on a light and I still wasn't seeing clearly and I grabbed a flashlight and I was about to shove a box back there, and I stopped short because right in the middle of that shelf was a spider web with a big black widow spider.

Paula Begoun:

Oh my gosh.

Bryan Barron:

Right in the middle of it. And the hairs on the back of my neck stood up. I don't have a spider phobia.

00:21:30

And I'm the kind of person that will catch a spider in the house and let it go outside.

Paula Begoun:

Oh, you're so nice!

Bryan Barron:

I'll kill a bee with the best of them, but…

Paula Begoun:

Yeah. I'm allergic to bees.

Bryan Barron:

But spiders, I'm like, you know, they do a lot of good. But the black widow, and it was very obvious that's what it was, freaked me out. I literally backed out of the garage. I couldn't take it.

Paula Begoun:

Well, if you do get bit by anything and it swells up and quickly you have -- especially with the risk of some forms of anaphylactic shock, you've got to get yourself to either an emergency room or a dermatologist.

Bryan Barron:

Yeah.

00:22:03

The throat swells up.

Paula Begoun:

Treatment of scars. There are definitely over-the-counter scar treatments that can make a huge improvement in the appearance of scars, but limited. It's limited. Especially if it's a keloid scar, or a deep track scar. And then you do want to consider talking to a dermatologist who can reset -- I think it's called resection.

00:22:32

Where you can cut into it or laser it and reform it and make it look better. Not all scars can be treated over-the-counter. Some can be treated with silicone pads. There are scar treatments.

Bryan Barron:

We have our new clinical scar reducing serum that we launched.

Paula Begoun:

Right. And you said you had an interesting experience using it.

Bryan Barron:

Yeah. I'm still using it. Last fall, just before Thanksgiving, I had a couple of moles removed from my leg.

00:23:00

I get a skin cancer check every year and the derm, it was Dr. Rogers…

Paula Begoun:

Oh yeah.

Bryan Barron:

From Madison Skin, she said, "You know, I'd like to take those off and biopsy them; make sure that they're fine." And what am I going to do, say no? So, they did that and I was left with the hole, and you do get a hole, closed up. It healed quite well. And so now everything is flush with the surrounding skin, but it's red. Just kind of red and a little bit rough texture and angry looking as I like to call it.

Paula Begoun:

Really?

Bryan Barron:

I've been using the Scar Reducing Serum for about six weeks now.

00:23:35

And I'll have to show you in an appropriate setting how much better. I wish I had taken a picture of what they looked like before because they're so much lighter now.

Paula Begoun:

No kidding?

Bryan Barron:

It's just like, I mean, a scar can continue to heal and change for up to two years.

Paula Begoun:

Right.

Bryan Barron:

We know this. But, I'm seeing…

Paula Begoun:

It's rapid?

Bryan Barron:

It's like this scar serum is turbo-charging it. Because it just wasn't -- I thought it kind of got to a point of its own where it just sort of, well, that's about as good as it's going to get.

Paula Begoun:

No kidding? Oh, I'm impressed.

00:24:05

Okay, so you have to go put your review up on the…oh, you did. You said you put your review up on the website.

Bryan Barron:

I did! I don't know if it's been approved yet. They're a little bit behind in doing that. Actually, by the time you're hearing this show it will probably be up there. So, if you see a review for the scar gel that has Bryan on it, it's probably mine.

Paula Begoun:

And when we say approved, we don't edit reviews. The only reviews we don't put up are when people use inappropriate language.

Bryan Barron:

Sure.

Paula Begoun:

So, if you don't see your review up there it's because you either said something just so vile and nasty that we can't, or used language that we simply can't put up.

00:24:47

But we don't edit for content in terms of the quality of reviews. We let reviews, whether you like us or don't like us. But it has to be about our products, not about how much you hate me. No one hates Bryan, but everybody…

Bryan Barron:

Well…

Paula Begoun:

Do you get nasty? Not as much as me.

Bryan Barron:

Sometimes. Probably, no, you get more.

Paula Begoun:

I get more. I'm so lucky!

Bryan Barron:

But, also, just for those who have submitted reviews on the Paula's Choice site, it generally takes about three to five days for them to show up on the site.

00:25:17

So, I know sometimes customers tend to get anxious when they don't see their review right away, or the next day. It's not because we're ignoring you. It's just sometimes we get a little backed up.

Paula Begoun:

The other reason to see a dermatologist for brown skin colorations that are sun-induced, that are clearly sun damage spots, as we were saying you could treat it with a 2% hydroquinone product. Paula's Choice sells a 2% hydroquinone product. There are other companies that sell 2% hydroquinone products that you can find on Beautypedia.com. There's also skin lightening products that use alternative ingredients.

00:25:58

We even have one that uses alternative ingredients, although hydroquinone is still considered state of the art. However, at 2%, sometimes you have to go up to 4%. You still have to be neurotic about a sunscreen. However, one of the things that can happen is even with the best products you can have just very recalcitrant, stubborn brown spots. And then there are lasers and light treatments that a doctor can use and really, really, really get rid of them.

00:26:30

Now, to maintain it you might still want to use a hydroquinone product or a skin lightening product. You absolutely should always use sunscreen. But some brown skin discolorations are absolutely the realm of the dermatologist.

Bryan Barron:

Particularly Melasma, also known as the Mask of Pregnancy.

Paula Begoun:

Which isn't just the little round brown spots, but a swatch of brown over the face.

Bryan Barron:

Yeah. Typically seen around the perimeter of the face where the entire perimeter is noticeably darker than the center of the face. It can happen in women of any skin color.

00:26:59

Obviously it's more prominent the white you are. That contrast is going to be more obvious. But Melasma can be really stubborn.

Paula Begoun:

Very stubborn.

Bryan Barron:

There's more of a hormonal component to it.

Paula Begoun:

Right. Actually, I think it's strictly hormonal. Just can darken. It just can worse with sun exposure. So, you still need to be very, very good about sunscreen.

Bryan Barron:

And most cases require a multi-product or multi-pronged approach where you're not only using over-the-counter products, you're using prescription topical. You may be getting laser treatments. Or you may be getting peels or some other combination that you need to work with a dermatologist.

00:27:34

And unfortunately there isn't a slam dunk solution for every case.

Paula Begoun:

Right.

Bryan Barron:

What works for one person with Melasma may not work at all for somebody else. And we know that's incredibly frustrating. The same is true for acne. And skin can be finicky.

Paula Begoun:

The good news is that for brown discolorations like that, again, that you've watched them, and you've checked them, and they don't fall into the skin cancer category, they're not dangerous. And you can just try treating them over-the-counter.

00:28:08

If that's not working, if you really want to do something definitive when over-the-counter doesn't work then you do need to see a dermatologist. Let's talk about when you don't need to see a dermatologist because there are times where people visit a dermatologist and they're not going to be, well, either not well taken care of because it's really not their area of expertise, or you're just going to waste money when you could have taken care of it yourself.

00:28:33

One of the things we were saying earlier is for mild to moderate acne. There's even studies that have been published in the American Academy of Dermatology, that have been studied in the Journal of American Medical Association, the acronym for that is JAMA, that says you need to start with benzoyl peroxide. That over-the-counter benzoyl peroxide can be better than almost anything you might get in a prescription form from a dermatologist.

00:28:58

And we feel the research strongly shows that a salicylic acid product with a benzoyl peroxide product, assuming none of it contains irritants, you're going to get great results. You're going to get great results for treating Keratosis Pilaris, which are the red bumps on your thighs and the back of your arms with a 2% salicylic acid product. There isn't anything really a dermatologist can prescribe that would be any better or any different.

Bryan Barron:

Well, and typically what they'll recommend is a product called Lac-Hydrin.

Paula Begoun:

Oh, lactic acid.

Bryan Barron:

Either Lac-Hydrin 5 or Lac-Hydrin 12, or there's another product called AmLactin which contains -- it's also lactic acid but it has ammonium lactate.

00:29:41

AHAs can help with keratosis pilaris. Some people find they work great. But generally because of the nature of that condition you want a BHA exfoliant, which is salicylic acid, because it's just better at getting to the root of the problem. And BHA is a natural anti-inflammatory. Keratosis pilaris is almost always red. BHA is going to help reduce that redness in a way that AHA can't.

Paula Begoun:

Right.

Bryan Barron:

So, what we often would hear from women is, "I have these bumps. It looks like chicken skin. I went to my dermatologist. He told me to use AmLactin. I did as he said and nothing changed."

Paula Begoun:

And then we said the 2% salicylic acid.

Bryan Barron:

In more than one case I've sent these women a tube of our Weightless Body Treatment with 2% BHA, always with the proviso that I'm not going to guarantee this is going to work, because it doesn't work for everyone.

Paula Begoun:

Doesn't work for everyone.

Bryan Barron:

But it's absolutely worth trying.

Paula Begoun:

Right.

Bryan Barron:

You have nothing to lose.

Paula Begoun:

But either way, even if you do want to try what derms recommend, it's over-the-counter.

00:30:39

It's right there at the drugstore. You don't have to have the derm tell you to go get the AmLactin or to use a 2% salicylic acid product, which are the only options. The other thing is dandruff. Now, for very severe Seborrheic dermatitis, you do need to see a dermatologist. But in terms of dandruff, the over-the-counter products from Head & Shoulders to Nizoral, which contains Ketoconazole.

00:31:08

The Coal Tar products from Neutrogena. The T/Gels. The products that are over-the-counter for treating dandruff, there really isn't anything that a dermatologist will prescribe that's over and above what you would get.

Bryan Barron:

The reason a lot of these products are now over-the-counter is because for years dermatologists did prescribe them and they have a long history of safe use.

And because these work so well in most cases there hasn't been a need to formulate something different.

Paula Begoun:

So, calluses are another thing, on the heels and elbows, that there is no reason really to see a dermatologist. The exception to calluses for a derm, because you could treat that with a lactic acid and a glycolic acid product, a salicylic acid product.

00:32:00

You can take a file that's used for the heels to exfoliate and then put a moisturizer over it, and a 2% salicylic acid, or a lactic acid, or a glycolic acid product. The exception to that rule is for people with diabetes who have severely cracked heels to the point where they're simply not healing. And sometimes that's more from neglect than just because of the diabetes.

00:32:27

But if you've let it go that badly where the heels are literally getting infected, then you absolutely must see a dermatologist. Although, you can try to treat it yourself by using a topical antibacterial product, being good about moisturizing, being good about using a lactic acid or alpha hydroxy acid product. Actually, they generally for diabetic skin, for some reason they don't recommend salicylic acid, but AHAs or [Ureas] seem to be fine.

00:32:58

But for the most part for calluses, for wearing sandals in the summer of spring, there is no reason to not treat that yourself. Wrinkles, other than cosmetic corrective procedures like lasers and fillers, for skincare, for general skincare for treating wrinkles and oily skin and dry skin, as wonderful as dermatologists are, and some dermatologists are absolutely invaluable and for fillers and some medications for some skin disorders, and for Botox and all kinds of things you absolutely must see a dermatologist.

00:33:39

But for general skincare, for products loaded with skin healing and skin repairing ingredients. For products that contain retinol, for exfoliants like salicylic acid and glycolic acid, for gentle cleansers, for all kinds of general skincare needs -- oily skin, to absorb oil, to reduce irritation, to reduce oil production -- that's all something that…

00:34:02

Well, first, I would come to PaulasChoice.com and CosmeticsCop.com and look at the information we have on the website to lead you in the direction of the best products that are out there, whether they're ours or someone else's. And also we can let you know when it is appropriate, what cosmetic corrective procedures can work with your skincare products. But for general skincare it really isn't necessary to talk to a dermatologist.

00:34:33

They often sell skincare products, but I can't tell you how many times I've been in dermatology offices where they're selling really either poorly formulated skincare products that contain irritants or alcohol or other drying agent, or they don't contain anything. They don't have antioxidants. They don't have skin repairing ingredients, or they come in jars.

00:34:56

Oh my gosh, they come in jars and air-sensitive, beautiful antioxidants, and the great plant extracts that can be antioxidants, and beautiful skincare ingredients don't hold up in jar packaging. It lets air in, lets your finger in. It's going to destroy those beautiful ingredients. And that is a huge problem. It's such a waste of money. And I see these in dermatology offices…

Bryan Barron:

Oh, all the time.

Paula Begoun:

All the time. All the time.

00:35:24

Dermatologists sell expensive sunscreens. Expensive sunscreens. Nobody knows better than dermatologists that you have to apply a sunscreen, say it together, LIBERALLY.

Bryan Barron:

LIBERALLY.

Paula Begoun:

A lot of it or you're not getting the SPF value on the label. Well, how liberally are you going to apply a $40, $50, $60, $70, $100 sunscreen? It's a sin.

00:35:58

I can't get over when I see that at a derm's office. And then I hear the receptionist go, "Oh, you only need to apply a little, itty, bitty bit." I want to kill. Because one is it's a lie. You need to apply a lot. Dermatologists selling expensive sunscreens -- I wish that was against their -- would take away their accreditation. I just think that's bizarre. The products that derms sell are not necessarily the best products out there. In fact, often they're some of the worst products out there. I mean, you can always go to Beautypedia and check out, or our book, "Don't Go to the Cosmetics Counter Without Me," and take a look at our product reviews on some of these products.

00:36:39

it's not that some of them aren't good, but there are so many of them that are either a problem because they're poorly formulated, or they're well-formulated, come in a jar. Or it's a sunscreen and it is an expensive sunscreen. Or, even if it's beautifully formulated, even if it's in great packaging, if there's a less expensive one that is as beautifully formulated, and comes in great packaging, why buy the expensive one?

Bryan Barron:

Which leads to the other point I wanted to make, which is that there is nothing different or above the level about the skincare products a dermatologist sells versus what you can get in a store or online.

00:37:20

You'll often hear the products described as being dermatologist-strength, or prescription-strength skincare, which has absolutely no regulation or meaning behind it. Anything could be prescription strength, just like anything could be hypoallergenic. There's no regulation behind that term either. The only products that a dermatologist can rightly say, "Yeah, you've got to come see someone like me to get that," would be prescription products, like 4% hydroquinone, tretinoin, other prescription retinoids like Tazorac or Differin.

00:37:51

Think medications. Think drugs. But not sunscreen. Not cleanser. Not moisturizer or eye cream. Even if it says it's for dark circles or puffiness, or a special toner that says it's for Rosacea. There's nothing medical or pharmaceutical about it. There's no reason that product couldn't be sold anywhere else.

Paula Begoun:

And we will tell you on Beautypedia where they're sold.

Bryan Barron:

Yes.

Paula Begoun:

I mean, again, it could be…

Bryan Barron:

If it's a good product and you want to buy it from your dermatologist, go for it. But just don't fall for the myth that this is some sort of special tier of skincare.

Paula Begoun:

Because my doctor is selling it.

Bryan Barron:

Yes.

Paula Begoun:

Exactly.

00:38:25

The other thing to kind of pay attention to when it comes to making a decision about seeing a dermatologist is sometimes we're just not patient. And we try a product, we see a blemish, one or two blemishes and we just have a panic attack. We get a little bit of a rash and we just go, "Oh my gosh, what's happening now?" And sometimes just following some of the recommendations we've been talking about, you can come to PaulasChoice.com and look up our articles and see what we recommend for, I mean, dozens and dozens of different skin conditions.

00:39:03

And try them and give them several weeks. Again, assuming nothing is exacerbating, nothing is swelling you up and you're not red and swollen. And we're talking about just skincare issues -- be patient.

Bryan Barron:

Yeah. Skin is not always instant gratification. And we live in that world. We live in a world of iPads and tablets and the internet where you can look up and find out anything in the blink of an eye.

Paula Begoun:

Right. Skin isn't always that accommodating.

Bryan Barron:

Right!

Paula Begoun:

Especially for disorders like the red bumps on the back of the arms and the legs, calluses…

Wrinkles, depends on what you're using. Exfoliants in particular, you can get some pretty amazing overnight results. But what antioxidants do…

Bryan Barron:

But even those will get better in time.

Paula Begoun:

Actually that's true. That they can give you overnight results but with time it will even get better, especially products like moisturizers that are loaded with antioxidants or contain sunscreens. That makes skin do better over time. It isn't immediate.

00:40:16

You can get immediate benefit. I always tell people when they say, "Oh, I used your product." And, by the way, let me be clear -- I love this kind of feedback where they'll say, "Oh, I used Paula's Choice and my skin was better in a day." I'm thinking that's probably, for the products this person says they're using it's probably because they were using before were so bad. My products could do nothing else but give them instant results by undoing the irritation and inflammation and bad ingredients that they were putting on their face from other products.

00:40:50

So, sometimes you can get that overnight, amazing reaction. But for the way most of these ingredients work, particularly sunscreens, particularly antioxidants and skin repairing ingredients, it takes awhile for those build up in the skin, to see better cell formation, to see a reduction in brown spots from skin lightening ingredients.

00:41:11

The skin has to slough and go through a process. So, you've got to patient for some of this and not expect that it's an hour and a half, or even a week or two weeks. At least for most conditions, at least three weeks, and really two to three months before you... -- Now, if you have a bad reaction, you get red and irritated and inflamed, stop. Then that's a problem. The product isn't working for you. Could be a bad product.

Bryan Barron:

Yeah. Don't try to power through that.

Paula Begoun:

Or just an allergic reaction. Yeah, exactly. That you can be impatient about. That isn't a good thing. But, in terms of really you see your skin doing a little bit better and a little bit better, take your time, be patient.

00:47:56

And then you'll see it through to the end. And have realistic expectations. If you've got sagging skin, I don't care whose product you're using, you aren't going to get a facelift in a bottle. You're not going to get Botox in a bottle. You're not going to get a laser treatment in a bottle. You can make skin look amazingly improved. It still doesn't replace cosmetic corrective procedures. It doesn't replace plastic surgery. I wish it did.

00:42:23

It doesn't. And I sell a skincare line. Believe me, I would love to lie to you -- well, I wouldn't love to -- but if I could say it worked as good as those treatments, then I would. But it's lying. It's lying.

Bryan Barron:

If you could legitimately state that.

Paula Begoun:

Thank you. That's a better way to say it.

Bryan Barron:

Then we would.

Paula Begoun:

Not that I would love to lie, but, you know, Paula's Choice…

Bryan Barron:

We're not going to lie. We're not going to tell you our products can do something that they cannot do. So, can we do a couple of questions and then wrap up?

Paula Begoun:

Yes. Sure.

Bryan Barron:

Okay. This is from Rose who is a loyal fan of over 20 years. Hi Rose.

Paula Begoun:

Am I that old?

00:43:01

Have I been around that long?

Bryan Barron:

Thanks for being with us for awhile.

Paula Begoun:

Hi Rose.

Bryan Barron:

So, she says, "Dear Paula, I read a sunscreen tip that I wanted to run by you. The tip is to use a well-formulated lip balm to add sunscreen around your eyes. The idea is that the lip balm will not run into your eyes and will stay on longer/better. What do you think? Lips and eyes, kills two birds with one easy-to-carry stone?"

Paula Begoun:

Uh, ha, well, it would depend what sunscreen ingredients were in the lip product.

00:43:31

Most lip products use synthetic sunscreen ingredients and I am one to not want -- I don't like recommending, particularly around the eye, synthetic sunscreen ingredients. It's not that synthetic sunscreen ingredients are bad, it's just that synthetic sunscreen ingredients are irritating. And particularly because of everybody being worried about puffy eyes and irritated eyes.

Bryan Barron:

They can be particularly irritating around the eyes.

Paula Begoun:

Exactly. I don't think that there's any less…

00:44:01

-- I think what the other faulty part of that information is that I don't think there's any less slippage from a balm. A balm is greasy. It moves. I don't think it would be any, I mean, balms move on the lips. They slide around on the lips. I don't think there's any less likelihood of getting in the eye.

Bryan Barron:

Yeah. Yeah.

Paula Begoun:

And you would still run the risk of getting it in the eye.

Bryan Barron:

Maybe not as fast, because most balms are anhydrous or waterless.

Paula Begoun:

Because they're thicker?

Bryan Barron:

Yeah.

Paula Begoun:

But they would eventually get emollient and…

Bryan Barron:

Eventually yes. Yeah. So, I guess if you're -- it's tricky. I don't think it's a slam dunk. I think it's maybe a bit better than using a lotion with those types of ingredients.

Paula Begoun:

Maybe.

00:44:44 Because that would slip faster.

Bryan Barron:

Right.

Paula Begoun:

Because it is less sticky. Well, that would be true. But I think it's, I guess it's more about if the stick only uses titanium dioxide and zinc oxide as the active ingredients, then I think you should absolutely give it a try. I don't know how well it would work under makeup, but I think it would be worth a try.

Then I wouldn't put that around the eye. But titanium dioxide and zinc oxide-based sunscreens around the eye are great. And, yes, you can try it in a balm.

Bryan Barron:

Okay.

00:45:32

One more. This is from Sue. "Dear Paula, I'll be 55 in a few months. And had a large brown spot about the size of a dime on my face. I apply foundation and concealer when I go out. I'm using your Resist Skin Lightening Lotion, and it did fade it about half of what it was. I tried Resist BHA 9, but that stubborn area just would not fade. I'm rarely in the sun, and if I do I use an umbrella to shade from the direct heat. I checked with a dermatologist and he suggests freezing the area…"

Paula Begoun:

No, no! Ah!

Bryan Barron:

"…like freezing a wart. And the brown area should be lighter."

Paula Begoun:

Ah! Ah! What is he a derm from 1940?

Bryan Barron:

She says, "I'm apprehensive taking this approach. That did not appeal to me. It may make it look worse because he said I could be left with a white patch."

Paula Begoun:

Oh my god! Who is this man?

Bryan Barron:

Well, she didn't say who her doctor was.

Paula Begoun:

Well, we wouldn't say on air.

00:46:22

But, so, freezing, god, I remember the days of when they used to freeze acne. They used to put, what is that called…?

Bryan Barron:

Liquid nitrogen.

Paula Begoun:

Liquid nitrogen on acne marks, blemishes, which just was terrible.

Bryan Barron:

I know they still do that for warts, but acne?

Paula Begoun:

Well, warts a different topic, different issue.

Bryan Barron:

Right.

Paula Begoun:

First of all, they're not on the face. They're on your hand. But in terms of the face, freezing things off is really a very old, old, OLD style of treating brown discolorations. All of the state of the art derms we talk to now use laser and light treatments to deal with brown spots in a way that doesn't damage skin.

00:47:14

The risk is small. You don't have to deal with the problems that come with freezing off brown spots. And you know something? You freeze off a brown spot, you are likely to get it back. You use a laser to get off a brown spot, you are unlikely to get it back. It's totally reversed. Freezing -- that just sounds like something, I mean, it's not medieval but it is a dated technique. The derm, well not in all due respect, because I'm fairly certain this is insulting, probably is too cheap to buy a laser machine or doesn't have a big enough practice.

00:47:49

Or, I bet you this derm is with an HMO and the HMO doesn't allow all their derms, in fact, they don't allow their derms to use lasers or cosmetic corrective procedures. There's only a very specialty department for that. So, an average derm at an HMO would only have freezing as an option. Please do not do that. See a derm who does cosmetic corrective procedures and knows the best lasers for doing that.

00:48:23

Yeah, so that's a very long answer to say, "NO!" Good thinking that you don't trust that information, because that is…

Bryan Barron:

Don't do it, Sue.

Paula Begoun:

Don't do it. That would be a big problem. Is that it? Is that everybody? Well, it's not everybody but we made a good dent. I love this topic -- "What the heck is that and when to see a dermatologist and when not to." So, I'm Paula Begoun with Bryan Barron, part of the Paula's Choice Research Team, keeping you beautifully informed. And we love doing our radio show. And how you come visit us and keep coming back and visiting us to see other shows we've done on PaulasChoice.com.